Celebrating Excellence: A Salute to Cardiac Cath Lab Nurses

Nurse’s Week allows us to set aside some time each year to acknowledge and celebrate the contribution nurses make in our world. This year, Nurse’s Week will be celebrated from May 6th (also known as Nurse’s Day) ending May 12th (Florence Nightingale’s birthday). Corazon would like to explore a little about what attracts people to select nursing as a career and to take this opportunity to applaud what they can, and do, contribute, to not only the cath lab team, but to healthcare every day.

The roots of the nursing profession extend back hundreds of years to the first “caregivers” who tended their sick, elderly or fragile family members. Nursing evolved from family care, out of necessity, as a means to have the resources to care for those injured in war, and finally, to a more organized and structured profession targeting the provision of care to the sick and infirmed in the hospital setting. While nursing had advanced out of the need for direct caregivers, over time there has been a huge emphasis on higher levels of knowledge, education, and the integration of technology into nursing practice.

Balancing the nurturing aspects of direct patient care with the use of science and technology to assist in the provision of that care has long held nursing at the center of the question “Is nursing an art or a science?” For most of us who choose nursing as a life-long endeavor, I would wager that neither of those things was forefront in our minds as we started our nursing career. Over my years in the nursing profession, I have encountered people who chose nursing for varied reasons, ranging from following in another family member’s footsteps, an affinity for biology and sciences, or just wanting to be in a profession of helping others. Whatever the reasons behind a choice of nursing as a career, once you have been in the profession for any length of time, it is easy to see there is something for everyone. While bedside nursing remains a mainstay of the profession, the nursing field has become highly diversified and opportunities abound for those who choose to embark on the nursing path. One can obtain a nursing diploma, an associate, bachelors, masters, or doctorate; or even extend to advanced practice nursing (clinical nurse specialist [CNS] or nurse practitioner [NP]). Others may decide to move to extended nursing fields, including certified registered nurse anesthetists (CRNAs). The environment for nursing practice ranges from hospitals, schools, and offices to business, consulting, research, academia, medical sales, and beyond. There appear to be limitless boundaries as to where nursing may lead. Each type of nursing provides an opportunity for the individual to shine a light on their strengths and what they can contribute for the patient.

For those who argue that nursing is an art, one might have to agree that being able to comfort those who are ill, discuss end of life with an ill patient’s loved ones, and calm the fears of a child would certainly qualify. Although you can teach techniques to accomplish those things, most individuals who enter the nursing profession have an innate ability to provide comfort and support and have exemplified that in their personal lives before pursuing a nursing career. The argument for nursing as a science is supported by the need for understanding science, biology, and technology as it applies to the care of patients. A nurse is not successful if he or she cannot understand the science behind the care and embrace the new technology that helps support it.  Yet one could consider, or may prefer, to step away from the art and science argument and just define nursing as a very special profession embraced by some very special people who accomplish many amazing things.

Nursing is not a standalone profession. Nursing, by itself, can accomplish many things; however, nursing within a healthcare team can do so much more. The real value of a nurse is the ability to apply all of the knowledge, skill, and compassion to the work the healthcare team is trying to accomplish. As a team member, nursing skills work in tandem with other healthcare providers (and their specialized skills) to accomplish something far more complex than each team member could accomplish on their own. Who from their early nursing education does not remember hearing “the whole is greater than the sum of its parts”? That can be applied to any team…but especially a cardiac cath lab team.

Perhaps that explains why, with the myriad of opportunities, many nurses are drawn to the cardiac cath lab. The cardiac cath lab is one of the areas of healthcare that best exemplifies how critical this concept of teamwork can be. Many nurses want to be a part of this very special team.  Let’s take a look at what the nurse has to offer. The registered nurse who moves to the cath lab generally has previous critical care skills and education, with a good handle on arrhythmias, 12-lead EKG, and hemodynamics. All of these things make him or her a valuable asset in the cath lab environment. Experience with complex medications such as glyboprotein IIb/IIIa inhibitors, vasopressors, vasodilators, and beta blockers, as well other cardiac pharmacology, makes them a valuable resource. An enhanced knowledge of all anatomy and physiology (and especially cardiac), as well as experience with emergency cardiac interventions, works in their favor. While all of these things are great when considering what a nurse can bring to the cardiac cath lab, more important is the ability to be a team player and to recognize his or her role as a “part” of a bigger picture. 

While procedures in the cardiac cath lab require individuals to scrub, monitor, and circulate on a case, the most important aspect of working in the cardiac cath lab is how the individuals in these roles work seamlessly together during the case. In other words: teamwork. When working in the cardiac cath lab, whether performing a routine diagnostic case or assisting in a complex, high-risk emergency cardiac intervention, the staff working together must use their skills and abilities to complement each other in order to provide the highest quality and most efficient care to the patient. Each member, be it a registered nurse (RN), radiologic technologist (RT) registered cardiovascular invasive specialist (RCIS) or cardiovascular technologist (CVT), are all an integral part of the team.

In our experience, articles that are about the concept of teamwork will indicate that the most important part is to recognize the value of individuals contributing to a single purpose or goal; in this case, the successful completion of a diagnostic or interventional cardiac procedure. What the nurse brings in skills is important, but what is of more importance is the ability to incorporate those skills and abilities with the skills and abilities of the other team members (whose expertise may include fluoroscopy, camera angulations, proficiency in sterile procedural technique, radiation safety, advanced hemodynamics, etc.) to produce the completion of a safe, efficient, precise, and successful procedure. The value of the nurse as a team member is for the other team members to call on his/her strengths and abilities. The ability to capitalize through learning, doing, and achieving is the ultimate reward. In his Cath Lab Digest article on orienting to the cardiac catheterization lab, Doug Langager, RCIS, comments, “On a successful team, teammates know the skills, weaknesses, and personal attributes of themselves and every other player, and they use this knowledge to succeed.”¹

It was while working in the cardiac cath lab that I personally found my greatest reward, and I would guess many other nurses would say the same. Most often, it was working in a very complex, high-risk, high-stress case that ended successfully for the patient — and that what made that particular case successful was the teamwork involved. When there was recognition of significant coronary lesions such as a left main, or severe triple-vessel disease, no one on the team ever panicked. Everyone just picked up the pace and worked together like a well-oiled machine. When the patient became hemodynamically compromised, there was nearly wordless communication to set up the intra-aortic balloon pump. The balloon kit magically appeared for hand-off to the field and the appropriate medications were administered. When the rhythm deteriorated and symptomatic bradycardia ensued, a temporary pacer wire and pacing generator were out and in place. That well-oiled machine, the team that builds on one another’s strengths and abilities, overcomes any individual weakness and keeps it all under control. It is at this time that the nurse is reaffirming why he or she decided to come to the cath lab…to be a part of something bigger than one’s self. And as an old cardiac cath lab nurse myself, my hope is that this is also when the rest of the team is glad that the nurse made the decision to come to the cardiac cath lab to be a part of the team.

Corazon salutes all of those individuals in the cardiac cath lab, but for this week in May 2011, we salute the nurse! It is in the cardiac cath labs where the individual tasks performed by the cardiologist, the CVT, RT, or the nurse do not make the procedure a success, but rather the success is attributable to the team. In any setting, the nurse has a role to play and the importance is not to shine as an individual, but to contribute to the work at hand so that all can shine as a team. Corazon applauds all nurses in all specialties, and for today, while letting the team shine as a whole, let’s let a little individual light shine on the nurse just a little bit brighter…just for today!

Reference

1. Langager D. Orientation “cardiac catheterization”. Cath Lab Digest 2006 Dec;14(12):23–37.

Marsha is a Senior Consultant at Corazon, Inc., offering the full continuum of services in the heart, vascular, and neuro specialties, including consulting, recruitment, and interim management. To learn more, visit www.corazoninc.com, or call (412) 364-8200. To reach Marsha, email mknapik@corazoninc.com.